| NPI | 1841615275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: TX S7140) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX S7140) |
| 208000000X Pediatrics (Licence: WI 65273-20) | |
| 208000000X Pediatrics (Licence: TX S7140) | |
| Enumeration Date | 2014-02-21 |
| Last Update Date | 2023-06-26 |