| NPI | 1255628616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2014022254) |
| Additional Taxonomies | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MO 2014022254) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2024-04-25 |