| NPI | 1679935530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD60947065) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA ML60657369) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2025-07-14 |