| NPI | 1801806054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO R6C25) |
| Additional Taxonomies | 2080P0204X Pediatrics Pediatric Emergency Medicine (Licence: MO R6C25) |
| 2080T0002X Pediatrics Medical Toxicology (Licence: MO R6C25) | |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2021-01-25 |