| NPI | 1164682712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: TX Q2373) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125.056686) |
| 208D00000X General Practice (Licence: MI 5101017822) | |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2015-08-12 |