| NPI | 1548251952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 170483) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX N4673) |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2024-04-05 |