| NPI | 1790711950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL me62688) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME0062684) |
| 208000000X Pediatrics (Licence: FL ME0062688) | |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: FL me62688) | |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2020-01-10 |