| NPI | 1639605389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 84796-20) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301501816) |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2025-06-26 |