| NPI | 1285097972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: NC 307977) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 278270) |
| 208000000X Pediatrics (Licence: NC 307977) | |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2022-07-29 |