| NPI | 1225092265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NC 9500574) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 9500574) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2026-07-24 |