| NPI | 1053598771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: TX M8247) |
| Additional Taxonomies | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: TX M8247) |
| Enumeration Date | 2008-01-24 |
| Last Update Date | 2019-10-24 |