| NPI | 1104069921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX N8417) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA 20A10755) |
| Enumeration Date | 2009-04-08 |
| Last Update Date | 2013-02-15 |