| NPI | 1629562921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: MN 76539) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 5101024202) |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2024-04-11 |