| NPI | 1558304584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics Pediatric Emergency Medicine (Licence: MA 227817) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 227817) |
| 2080S0010X Pediatrics Sports Medicine (Licence: MA 227817) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2007-08-17 |