| NPI | 1831488618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: FL ME135899) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC MD043305) |
| 208000000X Pediatrics (Licence: DC MD043305) | |
| Enumeration Date | 2011-04-01 |
| Last Update Date | 2018-08-01 |