| NPI | 1487617031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX N0905) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2006005746) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2024-07-08 |