| NPI | 1609261528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX U5821) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: CA A154474) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: OH 35.142651) | |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2025-06-27 |