| NPI | 1487943502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO 51051) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX BP10034363) |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2021-06-10 |