| NPI | 1003850173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MN 36869) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 36869) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2025-09-11 |