| NPI | 1871871616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0210X Pediatrics, Pediatric Nephrology (Licence: WA MD61687228) |
| Additional Taxonomies | 2080P0210X Pediatrics, Pediatric Nephrology (Licence: MI 4301097904) |
| 2080P0210X Pediatrics, Pediatric Nephrology (Licence: TX S4378) | |
| Enumeration Date | 2011-07-27 |
| Last Update Date | 2025-07-30 |