| NPI | 1851317432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX K0603) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OR 19837) |
| 208000000X Pediatrics (Licence: WA 31628) | |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2007-07-08 |