| NPI | 1932191657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics Pediatric Critical Care Medicine (Licence: GA 075396) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101236794) |
| 208000000X Pediatrics (Licence: MD D0071105) | |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2022-06-15 |