| NPI | 1689250219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: PA MT233155) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 322468) |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2025-08-08 |