| NPI | 1508805508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: DC MD500002654) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC MD500002654) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2026-01-28 |