| NPI | 1104173103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: IA MD-45420) |
| Additional Taxonomies | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: FL ME113571) |
| 208000000X Pediatrics (Licence: IA MD-45420) | |
| Enumeration Date | 2012-08-08 |
| Last Update Date | 2018-09-24 |