| NPI | 1902867039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: FL ME92195) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME92195) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2010-03-30 |