| NPI | 1154415644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics Pediatric Critical Care Medicine (Licence: CA C39203) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA C39203) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2008-07-10 |