| NPI | 1770952400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: AZ 63348) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA 138249) |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: CA A138249) | |
| Enumeration Date | 2015-09-23 |
| Last Update Date | 2022-08-23 |