| NPI | 1083078984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MI 5101024453) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 5101024453) |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2019-10-21 |