| NPI | 1003221474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MT 58500) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CO Dr.0065009) |
| 208000000X Pediatrics (Licence: TX Q0063) | |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2022-03-22 |