| NPI | 1811208655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: GA 93558) |
| Additional Taxonomies | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: OK 39757) |
| 208000000X Pediatrics (Licence: MA 255079) | |
| 208000000X Pediatrics (Licence: MA 245142) | |
| 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: OH 35.123695) | |
| Enumeration Date | 2010-06-26 |
| Last Update Date | 2025-09-09 |