| NPI | 1376983791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: GA 82688) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MS 878-L) |
| Enumeration Date | 2013-06-29 |
| Last Update Date | 2019-07-23 |