| NPI | 1568880144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: VA 0101262825) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101262825) |
| 207L00000X Anesthesiology (Licence: VA 0101262825) | |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2020-06-17 |