| NPI | 1245290295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT MD2648905) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT MD2641205) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2007-07-08 |