| NPI | 1417633546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 14298471-1204) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NE 9769) |
| Enumeration Date | 2023-06-23 |
| Last Update Date | 2026-07-31 |