| NPI | 1194081133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: KY 45016) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME122833) |
| 208000000X Pediatrics (Licence: KY 45016) | |
| Enumeration Date | 2012-04-04 |
| Last Update Date | 2021-01-09 |