| NPI | 1609897248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: NE 21523) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NE 10802) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2011-12-01 |