| NPI | 1629252457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NV 14909) |
| Additional Taxonomies | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: NY 244278-1) |
| 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: NJ 25MA08273000) | |
| Enumeration Date | 2007-12-28 |
| Last Update Date | 2018-08-30 |