| NPI | 1477119394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX U1302) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PR 34800R) |
| Enumeration Date | 2019-05-16 |
| Last Update Date | 2023-03-31 |