| NPI | 1376981332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD457860) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT205053) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: PA MT205053) | |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2019-11-08 |