| NPI | 1962934927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A158813) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 331248) |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2025-09-25 |