| NPI | 1639144504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX L2137) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX L2137) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2011-08-11 |