| NPI | 1790786184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX K6480) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA 422478) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2023-01-13 |