| NPI | 1972908978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: FL ME148702) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2016-02070) |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: NC 2016-02070) | |
| Enumeration Date | 2014-11-03 |
| Last Update Date | 2021-09-30 |