| NPI | 1144426198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX N2855) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: OK 25451) |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2013-07-23 |