| NPI | 1639309420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: FL ME125121) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WV 23707) |
| 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: WV 23707) | |
| Enumeration Date | 2009-07-15 |
| Last Update Date | 2015-10-15 |