| NPI | 1326018912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2018-01802) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL 40932) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2025-03-13 |