| NPI | 1164699773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX S3158) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA 20A11156) |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2023-07-19 |