Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | ME 101777 | FL |
N | 208000000X | Pediatrician | P9165 | TX |
N | 2080P0203X | Pediatric Critical Care Doctor | ME 101777 | FL |
Y | 2080P0203X | Pediatric Critical Care Doctor | P9165 | TX |
NPI | 1174725253 |
---|---|
Provider Name | Konstantinos Boukas |
First Address | Houston, TX 77030 |
Second Address | Houston, TX 77030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2007 |
Last Update Date | 24/09/2021 |