| NPI | 1558647289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: AL MD.42935) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AL MD.42935) |
| 208000000X Pediatrics (Licence: GA 80673) | |
| Enumeration Date | 2011-10-26 |
| Last Update Date | 2021-08-12 |