| NPI | 1477985497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX T9049) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 285071) |
| Enumeration Date | 2013-08-01 |
| Last Update Date | 2024-09-26 |