| NPI | 1790762805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: MA 77685) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 77685) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2016-08-10 |