| NPI | 1871757070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IL 125.054688) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 55876) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: WI 55876) | |
| Enumeration Date | 2008-07-16 |
| Last Update Date | 2021-07-30 |