| NPI | 1114931045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX N8606) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MS 19379) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2015-11-29 |