| NPI | 1932361078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX P7550) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 249270) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2018-03-20 |