| NPI | 1679992242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: CA A167988) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN 56537) |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2020-06-06 |