| NPI | 1245935642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC LL89732) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 9242126-1204) |
| Enumeration Date | 2023-04-04 |
| Last Update Date | 2026-05-14 |