| NPI | 1952308934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX L3770) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX L3770) |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2011-10-05 |