| NPI | 1093868796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: WI 53135) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 3534001204) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2013-02-11 |