| NPI | 1740207604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX M1256) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 15688R) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2009-01-02 |