| NPI | 1750467304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: HI MD-22958-0) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX K9880) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2023-02-09 |