| NPI | 1063464113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MD D47415) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101052828) |
| 208000000X Pediatrics (Licence: VA 0101052828) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2020-07-10 |