| NPI | 1306040985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: MN 65362) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY C1659) |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: KY C1659) | |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2023-11-07 |