| NPI | 1871756940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX S1877) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA02205) |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2020-06-11 |