| NPI | 1780334334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301516093) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101285204) |
| Enumeration Date | 2022-03-26 |
| Last Update Date | 2026-06-18 |