| NPI | 1467687319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: OK 30390) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 003778) |
| Enumeration Date | 2009-05-21 |
| Last Update Date | 2014-07-25 |