| NPI | 1205321163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX T4000) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX t4000) |
| 208000000X Pediatrics (Licence: CA 20A17994) | |
| Enumeration Date | 2018-06-24 |
| Last Update Date | 2024-02-21 |