| NPI | 1376818591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 262430) |
| Additional Taxonomies | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MA 262430) |
| Enumeration Date | 2012-03-21 |
| Last Update Date | 2017-01-10 |