| NPI | 1902819733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: WA MD60017625) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD60017625) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2011-09-13 |