| NPI | 1003226937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: CT 72243) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 285824) |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2022-10-26 |