| NPI | 1366625733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics Neonatal-Perinatal Medicine (Licence: FL ME107270) |
| Additional Taxonomies | 2080N0001X Pediatrics Neonatal-Perinatal Medicine (Licence: RI MD12520) |
| Enumeration Date | 2007-12-09 |
| Last Update Date | 2021-07-23 |