| NPI | 1609104785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX P4646) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2009-01988) |
| 208000000X Pediatrics (Licence: OK 28250) | |
| 208000000X Pediatrics (Licence: FL ME111094) | |
| Enumeration Date | 2009-11-30 |
| Last Update Date | 2023-08-02 |