| NPI | 1609095520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: KY 39290) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 39290) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2021-01-22 |