NPI | 1255590659 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: KY 44360) |
Additional Taxonomies | 208000000X Pediatrics (Licence: KY 44360) |
Enumeration Date | 2008-06-02 |
Last Update Date | 2012-10-29 |