| NPI | 1467712869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics Pediatric Critical Care Medicine (Licence: IA MD 40245) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IA MD 40245) |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2016-05-05 |