| NPI | 1265661508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: TX Q4212) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OK 27105) |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2015-07-28 |