| NPI | 1255727103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101280134) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME134036) |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2025-09-11 |