| NPI | 1265414460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: CA A45353) |
| Additional Taxonomies | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: WA MD61106174) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2021-02-05 |