| NPI | 1699161554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 10077811-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 10077877-1205) |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2026-06-17 |