| NPI | 1912497462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NV 21091) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX BP10063711) |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2021-07-06 |