| NPI | 1003506254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: UT 14279269-1205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD493022) |
| Enumeration Date | 2023-05-11 |
| Last Update Date | 2026-07-08 |