| NPI | 1497288013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX T7964) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OK 33093) |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2023-09-01 |