| NPI | 1831325851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX P8483) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OK 27138) |
| Enumeration Date | 2009-06-04 |
| Last Update Date | 2023-02-28 |