| NPI | 1760910251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: LA 335886) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 65795) |
| 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: WI 73004) | |
| Enumeration Date | 2017-05-26 |
| Last Update Date | 2023-07-19 |