| NPI | 1518426980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: GA 92047) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 92047) |
| Enumeration Date | 2019-03-15 |
| Last Update Date | 2025-06-06 |