| NPI | 1720406861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: WV 4970) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: PA OS022892) |
| Enumeration Date | 2014-04-05 |
| Last Update Date | 2026-06-12 |