| NPI | 1578957338 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2080C0008X Pediatrics, Child Abuse Pediatrics (Licence: NE 29726) | 
| Additional Taxonomies | 208000000X Pediatrics (Licence: NE 29726) | 
| Enumeration Date | 2015-03-19 | 
| Last Update Date | 2025-06-09 |