| NPI | 1366071094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: ID 9571956) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 5101027591) |
| Enumeration Date | 2020-04-04 |
| Last Update Date | 2025-07-28 |