| NPI | 1942266952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL 156152) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 68924-20) |
| 208000000X Pediatrics (Licence: IL 036104503) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2025-04-15 |