| NPI | 1255869426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX S6140) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT212744) |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2022-07-21 |