| NPI | 1558868455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN 63794) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX BP10063712) |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2022-03-31 |