| NPI | 1255628103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: MO 2011018222) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2011018222) |
| 208000000X Pediatrics (Licence: MO 2011018222) | |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2018-08-16 |