| NPI | 1972113579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX BP10071015) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD481188) |
| Enumeration Date | 2020-08-07 |
| Last Update Date | 2023-11-07 |