| NPI | 1275593717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 49110821205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 49110821205) |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2017-06-28 |