| NPI | 1255427274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX D2272) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101016182) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2021-11-05 |