| NPI | 1134654817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD61104698) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX BP10059344) |
| Enumeration Date | 2017-05-01 |
| Last Update Date | 2023-03-28 |