| NPI | 1083672109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MA 217373) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 217373) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2015-12-09 |