| NPI | 1326432568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: PA MT225062) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX R7373) |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2022-06-21 |