| NPI | 1477564763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics Pediatric Critical Care Medicine (Licence: MO R3B69) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO R3B69) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2007-07-12 |