| NPI | 1669552006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: CO 51012) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX M2307) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2012-07-03 |