| NPI | 1639678741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207SG0201X Medical Genetics, Clinical Genetics (M.D.) (Licence: MA 1019369) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PR 22541) |
| Enumeration Date | 2018-02-04 |
| Last Update Date | 2024-07-17 |