| NPI | 1689657793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 54409) |
| Additional Taxonomies | 2080P0204X Pediatrics Pediatric Emergency Medicine (Licence: MA 54409) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2015-12-01 |