| NPI | 1699082487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: TX Q9858) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX Q9858) |
| 208000000X Pediatrics (Licence: PR 12654) | |
| Enumeration Date | 2010-09-01 |
| Last Update Date | 2024-05-03 |