| NPI | 1154314904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: LA 14374r) |
| Additional Taxonomies | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: LA 14374R) |
| 208000000X Pediatrics (Licence: LA 14374R) | |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2011-02-04 |