| NPI | 1104065531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: MA 238833) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 238833) |
| Enumeration Date | 2009-02-09 |
| Last Update Date | 2011-02-04 |