| NPI | 1922365709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: MN 61263) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 63581) |
| 208000000X Pediatrics (Licence: MN 61263) | |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2019-04-09 |