| NPI | 1760505622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics Pediatric Emergency Medicine (Licence: TN 51244) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2006023041) |
| 207P00000X Emergency Medicine (Licence: TN 51244) | |
| 208000000X Pediatrics (Licence: TN 51244) | |
| Enumeration Date | 2007-04-07 |
| Last Update Date | 2015-04-27 |