| NPI | 1063703858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX q6091) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 249504) |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2025-08-20 |