| NPI | 1487699674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 39892-20) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 39892) |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2025-11-18 |