| NPI | 1427587955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: TX S5915) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX S5915) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2025-03-18 |