| NPI | 1205101714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: ND 13948) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IA 40161) |
| 208000000X Pediatrics (Licence: ND 13948) | |
| Enumeration Date | 2012-03-16 |
| Last Update Date | 2016-08-31 |