NPI | 1417519190 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: WV 35444) |
Additional Taxonomies | 208000000X Pediatrics (Licence: WV 35444) |
Enumeration Date | 2019-07-02 |
Last Update Date | 2025-08-22 |