| NPI | 1285748996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX G9139) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX G9139) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2007-09-07 |