| NPI | 1497940175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NM MD2010-0169) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 81746) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: AZ 78630) | |
| Enumeration Date | 2007-09-06 |
| Last Update Date | 2026-07-29 |