| NPI | 1902887706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 21581) |
| Additional Taxonomies | 174400000X Specialist (Licence: SC SC 21581) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2025-04-02 |