| NPI | 1649602590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: KY 48983) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301103661) |
| Enumeration Date | 2013-08-02 |
| Last Update Date | 2017-01-04 |