| NPI | 1760574180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX P3631) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN MD34622) |
| Enumeration Date | 2006-09-30 |
| Last Update Date | 2012-06-29 |