| NPI | 1023313772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A116897) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX N8431) |
| Enumeration Date | 2011-01-11 |
| Last Update Date | 2016-03-16 |