| NPI | 1497493779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IA R-12504) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: ID 5471054) |
| Enumeration Date | 2022-05-25 |
| Last Update Date | 2025-09-18 |