| NPI | 1255837969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX T5666) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX BP10063722) |
| 208000000X Pediatrics (Licence: FL ME148254) | |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2022-12-17 |