| NPI | 1285130807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 011148) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA 20A17808) |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2026-09-21 |