| NPI | 1790006708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX P6973) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC LL32790) |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2021-05-24 |