| NPI | 1174547608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: TX K7930) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX K7930) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2012-06-12 |