| NPI | 1700144649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2014-00986) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC MMD.23462) |
| 208000000X Pediatrics (Licence: TX U0618) | |
| 208000000X Pediatrics (Licence: AZ 67907) | |
| Enumeration Date | 2012-04-29 |
| Last Update Date | 2025-01-18 |