| NPI | 1235276148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME126218) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OK 24065) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2026-03-20 |