| NPI | 1366616583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX R9062) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 47119) |
| 208000000X Pediatrics (Licence: ME MD18839) | |
| Enumeration Date | 2008-04-18 |
| Last Update Date | 2025-12-16 |