| NPI | 1861609802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: WA MD60270977) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.093224) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2012-08-21 |