| NPI | 1790914760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MI 4301094404) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301094404) |
| 208000000X Pediatrics (Licence: NY 251498) | |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: NY 251498) | |
| Enumeration Date | 2009-07-10 |
| Last Update Date | 2012-05-07 |