| NPI | 1275191280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD61309806) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OR MD211848) |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2025-12-23 |