| NPI | 1194172494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX S1209) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX BP10055837) |
| Enumeration Date | 2016-05-17 |
| Last Update Date | 2021-02-01 |