| NPI | 1194929752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO 51278) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX BP1-0023109) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2021-05-04 |