| NPI | 1518957471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX Q3336) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101235945) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2026-01-14 |