| NPI | 1235660176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NV DO3964) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OR DO196972) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2025-12-08 |