| NPI | 1790714640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN MD11056) |
| Additional Taxonomies | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: TN MD11056) |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2007-07-08 |