| NPI | 1285074351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101257478) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2024-03-28 |