| NPI | 1346404191 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: MO 2011010499) | 
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2011010499) | 
| Enumeration Date | 2008-07-10 | 
| Last Update Date | 2021-01-15 |