| NPI | 1992095335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: NM MD2016-0958) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NM MD2016-0958) |
| Enumeration Date | 2011-04-18 |
| Last Update Date | 2017-10-02 |