| NPI | 1649663733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA OS024238) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0102205428) |
| Enumeration Date | 2015-03-12 |
| Last Update Date | 2025-02-24 |