| NPI | 1245225002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX N3487) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME86843) |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2015-11-09 |