| NPI | 1740274208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: NY 247159) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35084926) |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2010-02-03 |