| NPI | 1164653929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL OS11615) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OK 4739) |
| 208000000X Pediatrics (Licence: TX P0550) | |
| Enumeration Date | 2009-07-28 |
| Last Update Date | 2022-07-28 |