| NPI | 1205357969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: TX S7630) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX S7630) |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2024-04-23 |