| 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 |