| NPI | 1982699609 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: WI 70551)  | 
| Additional Taxonomies | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: IA 26987)  | 
| Enumeration Date | 2005-09-19 | 
| Last Update Date | 2024-04-09 |