| NPI | 1942384052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX N0374) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN MD40007) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2008-07-17 |