| NPI | 1518387141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: CA A168713) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A168713) |
| 208000000X Pediatrics (Licence: OH 35.130982) | |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2020-07-13 |