| NPI | 1912585738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: ID 7771767) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 7029901-1204) |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2025-08-26 |