| NPI | 1629064134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: GA 070804) |
| Additional Taxonomies | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: LA 15263R) |
| 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: LA MD.15263R) | |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2014-01-13 |