| NPI | 1104195379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX P8416) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX P8416) |
| 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: TX P8416) | |
| Enumeration Date | 2011-12-18 |
| Last Update Date | 2024-09-20 |