| NPI | 1497319065 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: MN 67759) | 
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 30258) | 
| 208000000X Pediatrics (Licence: WI 13525-320) | |
| 208000000X Pediatrics (Licence: MN 67759) | |
| Enumeration Date | 2019-04-29 | 
| Last Update Date | 2025-08-11 |