| NPI | 1225061104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX K5093) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX K5093) |
| 208000000X Pediatrics (Licence: TX k5903) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2025-01-10 |