| NPI | 1659001964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX BP10078881) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX V9171) |
| Enumeration Date | 2022-06-10 |
| Last Update Date | 2025-11-05 |