| NPI | 1316517642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NE 2772) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 14280681-1204) |
| Enumeration Date | 2021-06-29 |
| Last Update Date | 2026-04-27 |