| NPI | 1134570534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX T6175) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301110152) |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: TX T6175) | |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2022-10-07 |