| NPI | 1467480335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: CO 33817) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 33335) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MN 33335) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2019-07-18 |