| NPI | 1053716639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: WA MD61557815) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD61557815) |
| Enumeration Date | 2014-10-25 |
| Last Update Date | 2024-07-25 |