| NPI | 1386063998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: TX U2677) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PA OS017912) |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2023-03-07 |