| NPI | 1093129686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: OK 6171) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX BP10050867) |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2022-07-21 |