| NPI | 1417034273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: NY 241351) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 241351) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: GA 060497) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2011-09-15 |