| NPI | 1174966477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: WA OP60632905) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA OP60632905) |
| 208000000X Pediatrics (Licence: NE 1229) | |
| 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: NE 1229) | |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2021-04-14 |