| NPI | 1902369838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX U3522) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ R77273) |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2024-03-13 |