| NPI | 1063890416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: SC 89495) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2018-00690) |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2023-07-03 |