| NPI | 1144663907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 274823) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A131895) |
| 208000000X Pediatrics (Licence: TX R3246) | |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2020-02-06 |