| NPI | 1912935719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: NC 2005-01369) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2005-01369) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2022-07-21 |