| NPI | 1609857341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WV 32946) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 36724) |
| 208000000X Pediatrics (Licence: KY 50869) | |
| 208000000X Pediatrics (Licence: AL 25659) | |
| 208000000X Pediatrics (Licence: KY TP229) | |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2025-05-13 |