| NPI | 1386130656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: FL ME170832) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA HS000003L) |
| Enumeration Date | 2018-07-10 |
| Last Update Date | 2025-07-23 |