| NPI | 1689661407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2010017417) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AR E-9985) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MO 2010017417) | |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2018-05-30 |