| NPI | 1699188821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080C0008X Pediatrics, Child Abuse Pediatrics (Licence: TX R3166) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301105696) |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2020-08-14 |