| NPI | 1124251798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0116021230) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101252907) |
| Enumeration Date | 2009-08-31 |
| Last Update Date | 2022-05-17 |