| NPI | 1528453891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX U4778) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 310387) |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2025-12-08 |