| NPI | 1245202415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX Q2394) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA AFE65527) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2019-10-24 |