| NPI | 1780680546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA C53259) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX K1668) |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2020-05-29 |