| NPI | 1235413030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: WV 30226) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NE 27418) |
| 208000000X Pediatrics (Licence: CA A118536) | |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: OK 30469) | |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: KS 04-39698) | |
| Enumeration Date | 2011-09-28 |
| Last Update Date | 2022-04-07 |