| NPI | 1407349574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: WA MD61259452) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT215206) |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2025-05-03 |