| NPI | 1235209644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX p9084) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101239615) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2024-03-04 |