| NPI | 1962864314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: CA A170261) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A170261) |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2025-04-04 |