| NPI | 1790798742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CT 36704) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 036704) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2025-03-26 |