| NPI | 1215908793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA C200208) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI TX78240) |
| 208000000X Pediatrics (Licence: WY 16595A) | |
| 208000000X Pediatrics (Licence: TX E4281) | |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2026-06-24 |