| NPI | 1760616411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics Neonatal-Perinatal Medicine (Licence: FL ME118770) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A107588) |
| Enumeration Date | 2009-05-11 |
| Last Update Date | 2018-03-29 |