| NPI | 1003996349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2008-00653) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX L7214) |
| 208000000X Pediatrics (Licence: FL ME0089059) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2013-08-06 |