| NPI | 1164699773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX S3158) |
| Additional Taxonomies | 2083C0008X Preventive Medicine, Clinical Informatics Specialist (Licence: TX S3158) |
| 208000000X Pediatrics (Licence: CA 20A11156) | |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2025-10-30 |