| NPI | 1366657348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MA 235614) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 235614) |
| 208000000X Pediatrics (Licence: RI MD12930) | |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2020-11-10 |