| NPI | 1891058178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: MA 262683) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 253216) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2018-05-01 |