| NPI | 1801456629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0205X Pediatrics, Pediatric Endocrinology (Licence: CA A179328) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A179328) |
| 208000000X Pediatrics (Licence: MI 4351045090) | |
| Enumeration Date | 2019-06-14 |
| Last Update Date | 2025-07-14 |