| NPI | 1053353961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX F1889) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX F-1889) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2016-07-24 |