| NPI | 1689863649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX P4118) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OR MD27655) |
| Enumeration Date | 2007-10-16 |
| Last Update Date | 2019-05-06 |