| NPI | 1720255649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: DC MD041350) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101249131) |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2026-01-20 |