| NPI | 1548601586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: OK 38618) |
| Additional Taxonomies | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: MO 2016016738) |
| Enumeration Date | 2013-07-06 |
| Last Update Date | 2022-07-26 |