| NPI | 1558524504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics Neonatal-Perinatal Medicine (Licence: TN 46073) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 40745) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2010-06-29 |