| NPI | 1023498052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: VA 0102206673) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KS 94-08685) |
| 208000000X Pediatrics (Licence: VA 0102206673) | |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2024-06-25 |