| NPI | 1851020994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 85774) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IA R-12615) |
| Enumeration Date | 2022-06-06 |
| Last Update Date | 2026-06-09 |