| NPI | 1124219308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX N5621) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX BP10029673) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2013-08-09 |