| NPI | 1518939214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX m9068) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 36421) |
| 208000000X Pediatrics (Licence: FL ME99888) | |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2014-04-25 |