| NPI | 1639563604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: TX R5230) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ 55855) |
| 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: AZ 55855) | |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2023-04-07 |