| NPI | 1104203769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: AZ 72527) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ 72527) |
| 208000000X Pediatrics (Licence: TX R8114) | |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: TX R8114) | |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2024-09-17 |