| NPI | 1578138244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA211691) |
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: NC 0010-11278) |
| 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: NC 0010-11278) | |
| Enumeration Date | 2021-05-25 |
| Last Update Date | 2022-08-22 |