| NPI | 1417916594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: TX M6359) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 5101016314) |
| Enumeration Date | 2006-03-19 |
| Last Update Date | 2016-08-12 |