| NPI | 1831261171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: TX u7834) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 48721-020) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2024-04-26 |