| NPI | 1508849969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: MA 51072) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 51072) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2014-07-17 |