| NPI | 1033813415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2026-01523) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2026-01523) |
| Enumeration Date | 2023-03-29 |
| Last Update Date | 2026-08-19 |