| NPI | 1134185457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: NV 6179) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35062020) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2016-11-22 |