| NPI | 1982048989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MI 4301109470) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301109470) |
| Enumeration Date | 2013-04-20 |
| Last Update Date | 2018-12-11 |