| NPI | 1902881717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 200200544) |
| Additional Taxonomies | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: NC 200200544) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2009-07-06 |