| NPI | 1477567758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: TX N1035) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 218857) |
| 208000000X Pediatrics (Licence: NY 218857) | |
| 208000000X Pediatrics (Licence: TX N1035) | |
| 207P00000X Emergency Medicine (Licence: AZ 71237) | |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2023-09-23 |