| NPI | 1497999056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A068368) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX J8810) |
| Enumeration Date | 2009-04-27 |
| Last Update Date | 2012-06-20 |