| NPI | 1588044630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MT MED-PHYS-LIC-67234) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: MT MED-PHYS-LIC-67234) |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2026-07-21 |