| NPI | 1225111974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: MN 40598) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 40598) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2012-10-26 |