| NPI | 1427510528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2025-01030) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 315544) |
| Enumeration Date | 2019-04-05 |
| Last Update Date | 2025-09-19 |