| NPI | 1396474201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 84494-20) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX BP10080713) |
| Enumeration Date | 2022-06-07 |
| Last Update Date | 2025-07-24 |