| NPI | 1932191426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX K2395) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 10885R) |
| 208000000X Pediatrics (Licence: LA MD.10885R) | |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: TX K2395) | |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2016-04-21 |