| NPI | 1104837624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2008031392) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX L9603) |
| 208000000X Pediatrics (Licence: KS 04-33450) | |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2022-01-17 |