| NPI | 1821383688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2025-03910) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0102205061) |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2026-07-14 |