| NPI | 1811254287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 86345) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX Q5450) |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2023-06-05 |