| NPI | 1396278891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101266050) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: TX 838) |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2026-08-18 |