| NPI | 1497730774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO 0060438) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN 36948) |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2025-02-26 |