| NPI | 1922365899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: CO CDRH.0000352) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 64407-20) |
| 208000000X Pediatrics (Licence: CA 135871) | |
| 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: KS 04-42068) | |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2023-06-09 |