| NPI | 1851390454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX M1391) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NM 20030658) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2024-01-25 |