| NPI | 1346761079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NV DO3828) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX S4383) |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2025-06-09 |