| NPI | 1295908176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: TX R1285) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD445245) |
| Enumeration Date | 2008-04-10 |
| Last Update Date | 2017-01-23 |