| NPI | 1366490682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0102201876) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 5800150) |
| 208000000X Pediatrics (Licence: AL DO.1311) | |
| 208D00000X General Practice (Licence: VA 0102201876) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2026-04-22 |