| NPI | 1659767366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: VA 102204710) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 102204710) |
| Enumeration Date | 2015-04-09 |
| Last Update Date | 2025-01-30 |