| NPI | 1326583741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics Neonatal-Perinatal Medicine (Licence: MN 67006) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL UO3936) |
| 2080N0001X Pediatrics Neonatal-Perinatal Medicine (Licence: WI 67031) | |
| Enumeration Date | 2016-12-20 |
| Last Update Date | 2020-06-10 |