| NPI | 1336430008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX R2668) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AR E-8549) |
| Enumeration Date | 2011-04-28 |
| Last Update Date | 2026-08-21 |