| NPI | 1912961152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: WA OP60652225) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX J6639) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2022-01-24 |