| NPI | 1700974557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: NV 14837) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD M73699) |
| 208000000X Pediatrics (Licence: CA A97018) | |
| 208000000X Pediatrics (Licence: NV 14837) | |
| 208000000X Pediatrics (Licence: MD D0072485) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2018-03-29 |