| NPI | 1912022104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 297586) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: ME 014515) |
| 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: ME 014515) | |
| 208000000X Pediatrics (Licence: PA MD439872) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2021-01-06 |