| NPI | 1114922077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101255330) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PR 6155) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: PR 6155) | |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: VA 0101255330) | |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2023-07-27 |