| NPI | 1790784775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: CO 30059) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA 10319R) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2011-04-04 |