| NPI | 1114584703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101275296) |
| Additional Taxonomies | 207PP0204X Emergency Medicine Pediatric Emergency Medicine (Licence: VA 0101275296) |
| Enumeration Date | 2019-05-20 |
| Last Update Date | 2024-02-07 |