| NPI | 1619236627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: TX R8356) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX R8356) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: OK 31167) | |
| Enumeration Date | 2012-05-10 |
| Last Update Date | 2020-05-06 |