| NPI | 1417985888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0210X Pediatrics, Pediatric Nephrology (Licence: FL ME69909) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL me69909) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: FL me69909) | |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2011-09-29 |