| NPI | 1083821029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: TX U1402) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.093321) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: IN 01072502A) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2023-03-14 |