| NPI | 1174917322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: MN 71775) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 71775) |
| 208000000X Pediatrics (Licence: WA MD60868947) | |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2024-05-21 |