| NPI | 1619960457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: NC 9701199) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A 38694) |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2013-10-03 |