| NPI | 1578643219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 6264458 1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX F7506) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2021-11-17 |