| NPI | 1053308791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: LA MD203408) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN MD28126) |
| 208000000X Pediatrics (Licence: AL 27393) | |
| 208000000X Pediatrics (Licence: FL ME 0056444) | |
| 208000000X Pediatrics (Licence: VA 0101053281) | |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2015-01-13 |