| NPI | 1346511714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX Q3128) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX BP10042179) |
| Enumeration Date | 2012-01-18 |
| Last Update Date | 2015-03-09 |