| NPI | 1649488123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: WA MD60095154) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A99569) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2011-05-31 |