| NPI | 1194252460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NV 20174) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX FD0261949-1323) |
| Enumeration Date | 2017-05-17 |
| Last Update Date | 2020-08-27 |