| NPI | 1609141811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MS 23517) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: ND PT 12243) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MS 23517) | |
| Enumeration Date | 2012-03-21 |
| Last Update Date | 2017-05-22 |