| NPI | 1205089661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO DR.0077202) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 7148380-1205) |
| Enumeration Date | 2008-10-29 |
| Last Update Date | 2026-07-23 |