| NPI | 1740574615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD466876) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NV 16030) |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2025-07-08 |