| NPI | 1114423092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 82854-20) |
| Additional Taxonomies | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: WI 82854-20) |
| Enumeration Date | 2018-04-01 |
| Last Update Date | 2024-07-09 |