| NPI | 1982236105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: WA MD61677331) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 208000000X Pediatrics (Licence: CO DR.0066909) | |
| Enumeration Date | 2020-02-05 |
| Last Update Date | 2025-06-06 |