| NPI | 1487697892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: LA 014805) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX N2871) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2009-08-24 |