| NPI | 1225569254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA MD470591) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD470591) |
| 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: PA MD470591) | |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2026-03-16 |