| NPI | 1194110379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 295186) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX R7999) |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2023-01-03 |