| NPI | 1659831436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 1022342) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT224867) |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2025-05-13 |