| NPI | 1306229182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: FL ME150678) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 80138) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2022-01-09 |