| NPI | 1568849719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: ND 71710) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 71710) |
| Enumeration Date | 2015-04-27 |
| Last Update Date | 2024-03-06 |