| NPI | 1164797346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: WA MD60565171) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA ML 60292260) |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2019-06-13 |