| NPI | 1356658959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: WA MD60630913) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301095840) |
| Enumeration Date | 2010-09-03 |
| Last Update Date | 2022-08-10 |