| NPI | 1285671529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101-249736) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NH 33801) |
| 208000000X Pediatrics (Licence: MD D0102401) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2026-01-06 |