| NPI | 1164926804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: WA MD61143461) |
| Additional Taxonomies | 2080H0002X (Licence: WA MD61143461) |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2025-04-08 |