| NPI | 1114156221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2012019219) |
| Additional Taxonomies | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MO 2012019219) |
| Enumeration Date | 2009-07-09 |
| Last Update Date | 2015-06-24 |