| NPI | 1174894919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: OK 31249) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: RI MD13826) |
| Enumeration Date | 2012-01-25 |
| Last Update Date | 2016-12-22 |