| NPI | 1225457625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2017023798) |
| Additional Taxonomies | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MO 2017023798) |
| 208000000X Pediatrics (Licence: KS 04-40132) | |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: KS 04-40132) | |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2025-12-05 |