| NPI | 1336643634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2022-01142) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX T1350) |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2022-05-27 |