| NPI | 1639169360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: MA 216878) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 216878) |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2007-08-17 |