| NPI | 1154303139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX P0857) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX P0857) |
| 2080A0000X Pediatrics Adolescent Medicine (Licence: TX P0857) | |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2016-04-29 |