| NPI | 1760820260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: TX R2118) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX R2118) |
| Enumeration Date | 2013-06-06 |
| Last Update Date | 2020-07-17 |