| NPI | 1104937739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: WA MD00046858) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD00046858) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2008-05-01 |