| NPI | 1740239102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME135120) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX L6092) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2018-07-17 |