| NPI | 1316071616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: FL ME113088) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC LL 29095) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2012-07-09 |