| NPI | 1548757974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 334778) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ 62333) |
| Enumeration Date | 2018-04-20 |
| Last Update Date | 2025-06-18 |