NPI | 1760829147 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: FL ME129827) |
Additional Taxonomies | 208000000X Pediatrics (Licence: FL TRN18829) |
Enumeration Date | 2013-05-27 |
Last Update Date | 2020-10-06 |