| NPI | 1588168298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX U9481) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD.MD.70099028) |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2026-07-31 |