| NPI | 1275896532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MA 262141) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 262141) |
| 208000000X Pediatrics (Licence: PA MT201446) | |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2021-07-12 |