| NPI | 1720549454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: TX W3930) |
| Additional Taxonomies | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: OR MD215992) |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2026-07-20 |