| NPI | 1891933727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: CT 050576) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 244113) |
| Enumeration Date | 2009-01-30 |
| Last Update Date | 2012-06-29 |