| NPI | 1992982854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: CA A98564) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A98564) |
| 2080S0010X Pediatrics, Sports Medicine (Licence: CA A98564) | |
| Enumeration Date | 2008-01-23 |
| Last Update Date | 2013-05-08 |