| NPI | 1518318849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MI 4301116865) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301110761) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2022-06-15 |