| NPI | 1316301229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD61155148) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: ID M-16767) |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2025-08-08 |