| NPI | 1376828400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 82127) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX 207Q0000X) |
| 208000000X Pediatrics (Licence: TX P3404) | |
| Enumeration Date | 2011-10-20 |
| Last Update Date | 2023-10-05 |