| NPI | 1114967767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2006004155) |
| Additional Taxonomies | 2080P0204X Pediatrics Pediatric Emergency Medicine (Licence: MO 2006004155) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2023-07-28 |