| NPI | 1902880800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: KY 18654) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 18654) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2014-10-02 |