| NPI | 1649854605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ R3526) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ 011168) |
| Enumeration Date | 2021-05-06 |
| Last Update Date | 2026-01-23 |