| NPI | 1295785236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: WA MD60516236) |
| Additional Taxonomies | 174400000X Specialist (Licence: NV 10943) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2015-01-26 |