| NPI | 1265846158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: UT 10292173-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301104818) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2021-12-20 |