| NPI | 1912912064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN 59909) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX M0018) |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2022-03-22 |