| NPI | 1265886444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: CT 3318) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 64279) |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2026-04-28 |