| NPI | 1356306419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME138747) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: MD D0044819) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2026-03-17 |