| NPI | 1356613376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN 71669) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2014-01669) |
| 208000000X Pediatrics (Licence: NY 288880) | |
| 208000000X Pediatrics (Licence: IL 125060453) | |
| Enumeration Date | 2012-02-07 |
| Last Update Date | 2026-02-16 |