| NPI | 1093132177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A148270) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX Q6617) |
| Enumeration Date | 2014-03-26 |
| Last Update Date | 2017-09-08 |