| NPI | 1366704694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080H0002X Pediatrics, Hospice and Palliative Medicine (Licence: SD 10371) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC LL34855) |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2022-04-04 |