| NPI | 1912964453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MA 71206) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 71206) |
| 2080P0208X Pediatrics, Pediatric Infectious Diseases (Licence: MA 71206) | |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2007-10-27 |