| NPI | 1194118992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: PA MD464071) |
| Additional Taxonomies | 282NC2000X General Acute Care Hospital, Children (Licence: MI 4301106760) |
| Enumeration Date | 2015-03-18 |
| Last Update Date | 2024-05-20 |