| NPI | 1124223474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: FL ME 104137) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL TRN10251) |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2011-03-31 |