| NPI | 1922109115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: LA LA10486R) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 10486R) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2010-09-07 |