| NPI | 1053708503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: TX 44832) |
| Additional Taxonomies | 282NC2000X General Acute Care Hospital, Children |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2015-05-06 |