| NPI | 1316106511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN 49300) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX N9833) |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2019-01-17 |