| NPI | 1427315837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX S0856) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NE 27703) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: TX S0856) | |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2025-02-27 |