| NPI | 1710903257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX M8212) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 10915R) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2021-04-01 |