| NPI | 1881037448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX S8971) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 281387-1) |
| Enumeration Date | 2013-04-14 |
| Last Update Date | 2021-09-13 |