| NPI | 1528021557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME138722) |
| Additional Taxonomies | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: PR 11370) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2025-03-05 |