| NPI | 1790125458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME15503) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX BP1-0047139) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2025-07-31 |