| NPI | 1831477983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OR MD181839) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX P2116) |
| Enumeration Date | 2011-07-22 |
| Last Update Date | 2018-03-17 |