| NPI | 1275929143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX T9751) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 274880) |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2022-10-04 |