| NPI | 1639121072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX N5454) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 040270) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2017-10-12 |