| NPI | 1740455500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: DC 1548) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: DC MD035595) |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2012-03-08 |