| NPI | 1164884995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME149039) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX S1498) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2022-05-25 |