| NPI | 1487688750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 62161) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 103065) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2025-09-24 |