| NPI | 1780932541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: TX p7782) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2018-02673) |
| Enumeration Date | 2012-08-27 |
| Last Update Date | 2018-12-26 |