| NPI | 1235217050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OR MD155963) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD60238869) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2026-07-16 |