| NPI | 1790795136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: CA C146375) |
| Additional Taxonomies | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: WA MD00044856) |
| 208000000X Pediatrics (Licence: CA C146375) | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2026-08-19 |