| NPI | 1952388357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX H8233) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CO DR. 0054363) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2014-10-26 |