| NPI | 1245798180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: ID M-17656) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: ID M-17656) |
| Enumeration Date | 2019-03-11 |
| Last Update Date | 2026-03-03 |