| NPI | 1952500845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NV 16520) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX Q4824) |
| 208000000X Pediatrics (Licence: AZ 82189) | |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2025-02-03 |