| NPI | 1760402002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080H0002X Pediatrics, Hospice and Palliative Medicine (Licence: TX U5735) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 65581) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2025-10-02 |