| NPI | 1437203676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX H3477) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX H3477) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2010-03-12 |