| NPI | 1407126972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX G7689) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NM MD2011-0778) |
| Enumeration Date | 2011-12-30 |
| Last Update Date | 2011-12-30 |