| NPI | 1275102295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics Neonatal-Perinatal Medicine (Licence: MS 35578) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OK 38319) |
| Enumeration Date | 2021-06-23 |
| Last Update Date | 2025-07-07 |