| NPI | 1558343871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 3618) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA 20A15798) |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2025-10-14 |