| NPI | 1558504167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: SC 51306) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN MD0000049017) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: CO DR.0054786) | |
| Enumeration Date | 2009-04-13 |
| Last Update Date | 2022-07-21 |