| NPI | 1477545408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: TX R8914) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: HI MD9244) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2019-02-22 |