| NPI | 1619420528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: LA 331094) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 331094) |
| 208000000X Pediatrics (Licence: IL 125069244) | |
| Enumeration Date | 2016-07-27 |
| Last Update Date | 2023-02-08 |