| NPI | 1285853515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX N6424) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AR E-6015) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2022-10-24 |