| NPI | 1215179759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX P2628) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2018-00557) |
| Enumeration Date | 2009-03-30 |
| Last Update Date | 2021-10-21 |