| NPI | 1871024091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: NV 29538) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NV 29538) |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2026-08-17 |