| NPI | 1730176553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: AL MD.20842) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AL MD.21842) |
| 208000000X Pediatrics (Licence: CT 046936) | |
| 208000000X Pediatrics (Licence: AL MD.21842) | |
| 2080S0010X Pediatrics, Sports Medicine (Licence: CT 046936) | |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2019-09-18 |