| NPI | 1497985733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: CT 61134) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301095029) |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: KY 47870) | |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2022-04-14 |