| NPI | 1720275506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2010027808) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD.MD.70061718) |
| Enumeration Date | 2007-09-26 |
| Last Update Date | 2026-03-26 |