| NPI | 1851032619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A203679) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX BP10078875) |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2026-07-28 |