| NPI | 1326092941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX T2637) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CO 53428) |
| 208000000X Pediatrics (Licence: NM MD2019-1019) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2022-06-03 |