| NPI | 1770500662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: LA MD.09485R) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 09485R) |
| 208000000X Pediatrics (Licence: LA MD.09485R) | |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2013-04-26 |