| NPI | 1225092422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX L3062) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 056750) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2020-12-14 |