| NPI | 1831195882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A86339) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX L0074) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2012-11-20 |