| NPI | 1942223664 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA G80214)  | 
| Additional Taxonomies | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: AZ 43911)  | 
| 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: CA G80214)  | |
| Enumeration Date | 2006-07-25 | 
| Last Update Date | 2022-10-05 |