| NPI | 1093704835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MA 59854) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 59854) |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2013-11-18 |