| NPI | 1457702227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: ND 15640) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301109862) |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2026-06-23 |