| NPI | 1841744554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: AZ 76869) |
| Additional Taxonomies | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: NC 2022-01266) |
| 2080P0214X Pediatrics, Pediatric Pulmonology (Licence: NC 2022-01266) | |
| 282NC2000X General Acute Care Hospital, Children | |
| Enumeration Date | 2016-08-10 |
| Last Update Date | 2025-06-25 |