| NPI | 1215322318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080H0002X Pediatrics, Hospice and Palliative Medicine (Licence: CO DR.0074997) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX R5601) |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2025-07-01 |