| NPI | 1689102717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX S5280) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX BP10061558) |
| Enumeration Date | 2017-06-02 |
| Last Update Date | 2020-12-28 |