| NPI | 1881012052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VT 042-0014807) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD461152) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: PA MT205917) | |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2021-11-18 |