| NPI | 1649344524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: TX H4828) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX H2848) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: TX H4828) | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2024-06-17 |