| NPI | 1144464173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: TX P3640) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX BP1-0034630) |
| Enumeration Date | 2009-04-21 |
| Last Update Date | 2015-08-09 |