| NPI | 1639377864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics Neonatal-Perinatal Medicine (Licence: TX U3932) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD440526) |
| 208000000X Pediatrics (Licence: PA MT190455) | |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2024-04-16 |