| NPI | 1700971033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2024-00319) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 101242083) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2025-01-08 |