| NPI | 1063643732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: CA A129376) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 57015958) |
| Enumeration Date | 2009-07-29 |
| Last Update Date | 2014-12-08 |