| NPI | 1003865270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MA 57132) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 57132) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2007-08-16 |