| NPI | 1811302755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics Neonatal-Perinatal Medicine (Licence: WA MD61043218) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.131222) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2024-04-29 |