| NPI | 1598817876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: CA A117488) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD P20124) |
| 208000000X Pediatrics (Licence: MD D67965) | |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2015-03-04 |