| NPI | 1790830636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: NC 9901562) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 9901562) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2024-02-12 |