| NPI | 1548333875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PR 8801) |
| Additional Taxonomies | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: PR 8801) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2010-09-30 |