| NPI | 1164954780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NH 25021) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301503161) |
| 2080P0203X Pediatrics Pediatric Critical Care Medicine (Licence: MI 4301503161) | |
| Enumeration Date | 2017-04-02 |
| Last Update Date | 2023-12-01 |