| NPI | 1518202050 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIN KNUEVEN Credentialing Supervisor 567-585-1969 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080P0214X Pediatrics Pediatric Pulmonology |
| Additional Taxonomies | 2080P0203X Pediatrics Pediatric Critical Care Medicine |
| Enumeration Date | 2012-12-11 |
| Last Update Date | 2021-02-05 |