| NPI | 1396087979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: CA A157593) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NV 17041) |
| Enumeration Date | 2013-03-21 |
| Last Update Date | 2024-05-22 |