| NPI | 1790943165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: PA MD436459) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD436459) |
| 208000000X Pediatrics (Licence: NJ pending) | |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2023-06-01 |