| NPI | 1396096699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: TX R1454) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX BP10040075) |
| Enumeration Date | 2012-09-26 |
| Last Update Date | 2024-07-02 |