NPI | 1588632798 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: CA C5657204) |
Additional Taxonomies | 174400000X Specialist (Licence: MA 216212) |
Enumeration Date | 2006-03-14 |
Last Update Date | 2022-08-17 |