| NPI | 1154361798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX L5121) |
| Additional Taxonomies | 207PP0204X Emergency Medicine Pediatric Emergency Medicine (Licence: TX L5121) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2022-01-28 |