| NPI | 1508097221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 287432) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX N3807) |
| Enumeration Date | 2009-07-29 |
| Last Update Date | 2018-03-06 |