| NPI | 1962054189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX BP10067754) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301515952) |
| Enumeration Date | 2019-07-09 |
| Last Update Date | 2026-03-18 |