| NPI | 1750585642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: FL ME113930) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL TRN 10601) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2012-12-11 |