| NPI | 1649253840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD00039818) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: ID M-8243) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2025-07-09 |