| NPI | 1891770756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 33939) |
| Additional Taxonomies | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MN 48616) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2007-07-08 |