| NPI | 1558748988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX V5514) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NE 30670) |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2025-02-19 |