| NPI | 1215246202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: KY 45095) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 45095) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: FL ME123631) | |
| Enumeration Date | 2010-09-25 |
| Last Update Date | 2024-09-05 |