| NPI | 1689964801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: FL ME131747) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.123392) |
| Enumeration Date | 2011-04-08 |
| Last Update Date | 2017-12-08 |