| NPI | 1366768376 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX P6516) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX BP1-0036645) |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2014-11-28 |