| NPI | 1689981961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics Neonatal-Perinatal Medicine (Licence: CA A113911) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A113911) |
| Enumeration Date | 2010-09-08 |
| Last Update Date | 2017-06-07 |