| NPI | 1790049641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2016-01403) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 5536) |
| 208000000X Pediatrics (Licence: GA 074135) | |
| Enumeration Date | 2012-06-26 |
| Last Update Date | 2025-11-13 |