| NPI | 1104843655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO R2B16) |
| Additional Taxonomies | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MO R2B16) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2014-01-17 |