| NPI | 1003176769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: PA MD455823) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD455823) |
| Enumeration Date | 2012-05-29 |
| Last Update Date | 2024-05-21 |