| NPI | 1245720259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX T2840) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX BP10064499) |
| Enumeration Date | 2018-05-15 |
| Last Update Date | 2021-09-28 |