| NPI | 1487637260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA C160123) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 209851) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: CA C160123) | |
| Enumeration Date | 2005-11-25 |
| Last Update Date | 2019-07-01 |