| NPI | 1598701849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD61673723) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 246895) |
| 208000000X Pediatrics (Licence: WI 51544-020) | |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2025-09-16 |