| NPI | 1548434467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 77128) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NM MD20080118) |
| 208000000X Pediatrics (Licence: MS 21046) | |
| 208000000X Pediatrics (Licence: TX P1637) | |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2023-03-07 |