| NPI | 1104887397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NM MD2014-0474) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX H0601) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2022-05-04 |