| NPI | 1609218171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: KS 04-41527) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301103648) |
| Enumeration Date | 2013-07-24 |
| Last Update Date | 2019-04-06 |