| NPI | 1043494735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX N5969) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ 81019) |
| Enumeration Date | 2007-12-18 |
| Last Update Date | 2020-02-20 |