| NPI | 1205021961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: WA MD60690764) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD60690764) |
| Enumeration Date | 2007-09-06 |
| Last Update Date | 2019-06-24 |