| NPI | 1457384281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME78674) |
| Additional Taxonomies | 2080P0204X Pediatrics Pediatric Emergency Medicine (Licence: FL ME78674) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2022-07-07 |