| NPI | 1629417316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: TX S5625) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301103359) |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2023-04-05 |