| NPI | 1790707008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: MD D0080871) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.086878) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2016-08-30 |