| NPI | 1316232747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics Neonatal-Perinatal Medicine (Licence: TX Q1911) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX 27386955) |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2021-12-19 |