| NPI | 1467956516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 83450) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 327882) |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2026-09-14 |