| NPI | 1760663017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: FL ME103584) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2006-00583) |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2023-04-24 |