| NPI | 1366428641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX J5362) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX J5362) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2007-12-04 |