| NPI | 1366947780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2024008566) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 13074530-1204) |
| 208000000X Pediatrics (Licence: CA 24803) | |
| 208000000X Pediatrics (Licence: NV DO03095) | |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2025-12-16 |