| NPI | 1457593865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2010007576) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX N1659) |
| Enumeration Date | 2009-03-31 |
| Last Update Date | 2014-01-07 |