| NPI | 1114283652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: TX R6899) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AR E-9382) |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2021-04-09 |