| NPI | 1235794025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AL 46434) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY TP785) |
| 208000000X Pediatrics (Licence: KY 56984) | |
| Enumeration Date | 2019-05-07 |
| Last Update Date | 2025-11-18 |