| NPI | 1780207654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX U4452) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: TX U4452) |
| 208000000X Pediatrics (Licence: GA 94842) | |
| Enumeration Date | 2020-05-26 |
| Last Update Date | 2026-06-26 |