| NPI | 1972807022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A113567) |
| Additional Taxonomies | 2080N0001X Pediatrics Neonatal-Perinatal Medicine (Licence: CA A113567) |
| Enumeration Date | 2011-01-04 |
| Last Update Date | 2011-07-14 |