| NPI | 1518209907 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080H0002X Pediatrics, Hospice and Palliative Medicine (Licence: TX T6854) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 272251) |
| Enumeration Date | 2013-03-23 |
| Last Update Date | 2024-06-14 |