| NPI | 1578891719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: TX R7887) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 55997) |
| Enumeration Date | 2009-11-30 |
| Last Update Date | 2018-10-17 |