| NPI | 1285612119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: FL ME81290) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 219864) |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: NY 219864) | |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2022-02-14 |