| NPI | 1528042678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 038347) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2025-03380) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2026-02-06 |