| NPI | 1902857428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME161503) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PR 10285) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2025-02-12 |