| NPI | 1487760401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0205X Pediatrics, Pediatric Endocrinology (Licence: TX H2673) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX H2673) |
| 171000000X Military Health Care Provider (Licence: TX H2673) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2022-03-10 |