| NPI | 1710959333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.137998) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NY 219440-1) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2025-05-20 |