| NPI | 1932409133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MT 28240) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 43930) |
| Enumeration Date | 2010-10-22 |
| Last Update Date | 2025-04-15 |