| NPI | 1548309552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 7282401-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NM 2006-0234) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2012-10-11 |