| NPI | 1235625443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: GA 91345) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PR 14790-i) |
| Enumeration Date | 2018-07-11 |
| Last Update Date | 2023-08-13 |