| NPI | 1952309718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 5101014251) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI DM014251) |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2026-06-02 |