| NPI | 1710969415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: TX p2534) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD00049218) |
| 208000000X Pediatrics (Licence: AL 00025763) | |
| 208000000X Pediatrics (Licence: TX p2534) | |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2018-10-16 |