| NPI | 1871774166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX N3661) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA 103679) |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2010-02-02 |