| NPI | 1407120314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA C148210) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX BP10034704) |
| Enumeration Date | 2012-02-24 |
| Last Update Date | 2022-12-16 |