| NPI | 1821654559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: MA 1023604) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD478630) |
| Enumeration Date | 2019-05-17 |
| Last Update Date | 2025-06-16 |