| NPI | 1255719910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2023-01251) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC Pending) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: NC Pending) | |
| 2080C0008X Pediatrics, Child Abuse Pediatrics (Licence: NC Pending) | |
| Enumeration Date | 2015-05-14 |
| Last Update Date | 2023-06-21 |