| NPI | 1134786528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX T7531) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 10866) |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2022-06-22 |