| NPI | 1477529006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NH 8408) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 67822) |
| 208000000X Pediatrics (Licence: NC 2020-01293) | |
| 208000000X Pediatrics (Licence: PA MD466750) | |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2025-04-02 |