| NPI | 1053171322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 14240750-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 14240750-1205) |
| Enumeration Date | 2024-03-21 |
| Last Update Date | 2025-09-23 |