| NPI | 1114121787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX N3737) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX BP1-0026859) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2022-01-06 |