| NPI | 1689617086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: OH 35091363) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX M3400) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2008-10-03 |