| NPI | 1902185713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MN 58166) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 58166) |
| Enumeration Date | 2011-08-10 |
| Last Update Date | 2020-04-10 |