| NPI | 1154318970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: LA MD201511) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AL 00022864) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2015-01-21 |