| NPI | 1699270728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: SC 91584) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD473629) |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2025-12-31 |