| NPI | 1235128059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME74514) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 90350) |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2025-12-03 |