| NPI | 1104142371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: TX P6899) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX BP10036643) |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2022-11-07 |