| NPI | 1225188360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: WA MD60152464) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD D0064557) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2010-07-01 |