| NPI | 1598977209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA 390200000X) |
| Additional Taxonomies | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: WA Md60299588) |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: OR Md157697) | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2012-09-06 |