| NPI | 1871589929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX N5567) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD00043078) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2021-12-06 |