| NPI | 1679677934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: OR MD192634) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 44277) |
| 208000000X Pediatrics (Licence: WA MD 60149014) | |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: WA MD 60149014) | |
| Enumeration Date | 2006-09-08 |
| Last Update Date | 2019-07-17 |