| NPI | 1144210311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 78768) |
| Additional Taxonomies | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: MA 78768) |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2007-07-08 |