| NPI | 1407844111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN 39761) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 39761) |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2018-09-04 |