| NPI | 1679985592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: CA A149422) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: RI LP03102) |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: MA 295578) | |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2023-04-19 |