| NPI | 1912918574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 37888) |
| Additional Taxonomies | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: KY 37888) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2026-08-10 |