| NPI | 1851536791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD60228401) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OR MD154231) |
| Enumeration Date | 2008-12-05 |
| Last Update Date | 2026-03-27 |