| NPI | 1194119115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: WA MD60847137) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA ML60562628) |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2021-05-18 |