| NPI | 1013982974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX S7916) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 14634R) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2024-05-06 |