| NPI | 1760643811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: WI 69400) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2010020728) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MO 2010020728) | |
| Enumeration Date | 2008-06-21 |
| Last Update Date | 2018-07-10 |