| NPI | 1134314875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX P5242) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PR 26638R) |
| Enumeration Date | 2007-09-06 |
| Last Update Date | 2013-03-12 |