| NPI | 1689669954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 32024) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2014-01739) |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2026-03-30 |