| NPI | 1417991126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A89208) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX M7076) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2008-01-16 |