| NPI | 1225399116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME140301) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NE 29955) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: TX q3765) | |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2019-08-09 |