| NPI | 1477522373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 29525) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME115575) |
| 208000000X Pediatrics (Licence: PA MD 034462E) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2026-04-02 |