| NPI | 1710115092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX P3431) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: RI LP01589) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2015-04-01 |