| NPI | 1245807270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: UT 14211805-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX 726565) |
| Enumeration Date | 2021-06-08 |
| Last Update Date | 2025-03-19 |