| NPI | 1861879454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: MO 2018018520) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ R74890) |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: KS 04-44515) | |
| Enumeration Date | 2015-05-03 |
| Last Update Date | 2021-08-19 |