NPI | 1558824797 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: TX V8591) |
Additional Taxonomies | 208000000X Pediatrics (Licence: GA 10829) |
Enumeration Date | 2019-04-12 |
Last Update Date | 2025-05-17 |