| NPI | 1568542801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NM MD2018-0464) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX M2485) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2018-09-06 |