| NPI | 1225021256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX M9827) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 209528) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2024-03-04 |