| NPI | 1265113732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 82509) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2023019695) |
| Enumeration Date | 2023-07-27 |
| Last Update Date | 2026-05-14 |