| NPI | 1366902603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: TX T5974) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH na) |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2022-05-22 |