| NPI | 1902147804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 263699) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 289071) |
| 2080N0001X Pediatrics Neonatal-Perinatal Medicine (Licence: NY 289071) | |
| Enumeration Date | 2013-03-03 |
| Last Update Date | 2022-07-11 |