| NPI | 1699267666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX T8161) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 00000) |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2022-09-21 |