| NPI | 1558866608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MO 2022000892) |
| Additional Taxonomies | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: KS 04-45278) |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2025-12-05 |