| NPI | 1710310289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX V9055) |
| Additional Taxonomies | 2080S0012X Pediatrics Sleep Medicine (Licence: NE 31403) |
| Enumeration Date | 2013-08-19 |
| Last Update Date | 2025-08-12 |