| NPI | 1053846352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 84704) |
| Additional Taxonomies | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: TN 66051) |
| 208000000X Pediatrics (Licence: TN 66051) | |
| Enumeration Date | 2017-04-24 |
| Last Update Date | 2025-11-04 |