| NPI | 1164568655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A76363) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX M5161) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2021-05-05 |