| NPI | 1770779506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX N0342) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NM MD2007-0740) |
| Enumeration Date | 2007-09-14 |
| Last Update Date | 2020-10-30 |