| NPI | 1376862540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: WI 87) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IA R-8826) |
| Enumeration Date | 2010-05-26 |
| Last Update Date | 2025-04-26 |