| NPI | 1720282098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: FL ME113274) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PR 26238r) |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2016-10-20 |