| NPI | 1982043154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: ND 15772) |
| Additional Taxonomies | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: ND 15772) |
| 208000000X Pediatrics (Licence: MO 2016009670) | |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: MO 2016009670) | |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2021-10-22 |