| NPI | 1770574659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX M2926) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 216655-1) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2017-03-02 |