| NPI | 1447322490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: TX N7706) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NE 13775) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2011-09-06 |