| NPI | 1083810600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NE 25191) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX BP10028592) |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2023-07-13 |