| NPI | 1669472064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX E4295) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AR R2629) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2011-04-08 |