| NPI | 1326026121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX N1685) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ 34874) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2010-05-12 |