| NPI | 1063875292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX S0046) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX BP10055839) |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2024-05-10 |