| NPI | 1619219854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: TX S1337) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 65246) |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2022-09-14 |