| 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 |