| NPI | 1043211394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: TX J6743) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 30521) |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: KY 30531) | |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2008-08-01 |