| NPI | 1124098579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 14021) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AZ 14021) |
| 207P00000X Emergency Medicine (Licence: AZ 14021) | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2007-10-11 |