| NPI | 1568801926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX Q8118) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 5101020474) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: TX Q8118) | |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2023-11-09 |