| NPI | 1821195371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 47356531205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 47356531205) |
| Enumeration Date | 2006-09-19 |
| Last Update Date | 2021-12-10 |