| NPI | 1699725622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX K5664) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME78364) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2010-09-14 |