| NPI | 1932446218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: MS 23724) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301100126) |
| Enumeration Date | 2013-01-07 |
| Last Update Date | 2015-08-07 |