| NPI | 1063454064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: UT 165008-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 165008-1205) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2014-05-30 |