| 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 |