| NPI | 1336645472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2022019188) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX S5054) |
| Enumeration Date | 2018-04-05 |
| Last Update Date | 2023-11-16 |