| NPI | 1356736870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX T0682) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2019010691) |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2022-01-21 |