| NPI | 1124389093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX Q4132) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX PIT 566341) |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2022-01-25 |