| NPI | 1205161643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: ID M-12756) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ R71582) |
| Enumeration Date | 2009-10-02 |
| Last Update Date | 2015-07-07 |