| NPI | 1275274094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD61681769) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MDRE.ML.61296399) |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2025-08-13 |