| NPI | 1083008627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: MA 293248) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A154579) |
| 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: CA A154579) | |
| Enumeration Date | 2015-03-21 |
| Last Update Date | 2022-07-16 |