| NPI | 1063672061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: FL ME114498) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME114498) |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2019-01-04 |