| NPI | 1629039912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA C54192) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX L6935) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2014-04-07 |