| NPI | 1306040985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: MO 2026021953) |
| Additional Taxonomies | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: KY C1659) |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: WI 72811-20) | |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: MN 65362) | |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2026-07-18 |