| NPI | 1609988781 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208000000X Pediatrics (Licence: NH 12809) | 
| Additional Taxonomies | 2080H0002X Pediatrics, Hospice and Palliative Medicine (Licence: NH 12809) | 
| Enumeration Date | 2006-08-31 | 
| Last Update Date | 2022-10-18 |