| NPI | 1689012734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: MO 2013031947) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2013017018) |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2023-02-02 |