| NPI | 1104110188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: PA MD464004) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX p9715) |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2022-12-14 |