| NPI | 1346926854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A209474) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ R80523) |
| Enumeration Date | 2023-06-27 |
| Last Update Date | 2026-06-22 |