| NPI | 1093928913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX P3771) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME 98432) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2020-07-28 |