| NPI | 1407242712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AL MD.37302) |
| Additional Taxonomies | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: GA 88682) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: AL MD.37302) | |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2021-06-11 |