| NPI | 1255692067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX Q4962) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX BP10043772) |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2015-11-13 |