| NPI | 1417047390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics Pediatric Critical Care Medicine (Licence: TX N6822) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX N6822) |
| 208000000X Pediatrics (Licence: VA 0101239374) | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2022-03-28 |