| NPI | 1154787307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX S9407) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NM MD2022-0323) |
| 208000000X Pediatrics (Licence: NY 300619) | |
| Enumeration Date | 2016-01-04 |
| Last Update Date | 2023-08-21 |