| NPI | 1306172945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: TX temp med license) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX N4260) |
| Enumeration Date | 2009-11-01 |
| Last Update Date | 2021-09-17 |