| NPI | 1154770923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: CT 71457) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT210509) |
| Enumeration Date | 2016-06-12 |
| Last Update Date | 2023-09-05 |