| NPI | 1750458980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO 47304) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 5101014755) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2025-03-03 |