| NPI | 1316200710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: GA 92500) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301100459) |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: NC 212976) | |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2022-10-03 |