| NPI | 1720179963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics Pediatric Emergency Medicine (Licence: MA 74142) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 74142) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2015-02-26 |