| NPI | 1760412209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AR E-9583) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX V0415) |
| 208000000X Pediatrics (Licence: MO 2003020131) | |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2024-05-02 |