| NPI | 1376983536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: FL ME160215) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.128161) |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2024-02-12 |