| NPI | 1396823811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101236076) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA 170351) |
| 208000000X Pediatrics (Licence: WA MD60150791) | |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: WA MD60150791) | |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: VA 0101236076) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2021-09-21 |