| NPI | 1790733582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: SD 4674) |
| Additional Taxonomies | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: NV 3374) |
| 208000000X Pediatrics (Licence: SD 4674) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2008-11-13 |