| NPI | 1902461015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX T4268) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX 10067755) |
| Enumeration Date | 2019-05-03 |
| Last Update Date | 2022-06-08 |