| NPI | 1598112591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CT 64034) |
| Additional Taxonomies | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: MA 1013721) |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2023-09-11 |