| NPI | 1992907208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: WA 60153803) |
| Additional Taxonomies | 2080H0002X (Licence: IN 11012049A) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2010-08-06 |