| NPI | 1700085123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: TX M7564) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX M7564) |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2021-04-16 |