| NPI | 1225475916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: WA MD60942771) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: RI LP02937) |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2019-07-18 |