| NPI | 1205441292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 82104) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101284874) |
| Enumeration Date | 2020-09-15 |
| Last Update Date | 2025-09-30 |