| NPI | 1013328913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: PA OS020426) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 04084) |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2020-07-15 |