| NPI | 1205843927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NM MD2019-0730) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VT 42-0010915) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2025-04-02 |