| NPI | 1124409743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: FL ME162598) |
| Additional Taxonomies | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: PR 21055) |
| 208000000X Pediatrics (Licence: IL 125-067121) | |
| Enumeration Date | 2015-06-10 |
| Last Update Date | 2026-05-15 |