| NPI | 1851302574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OK 39095) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX L4307) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2025-08-01 |