| NPI | 1619471893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: CA A196458) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 287301) |
| 208000000X Pediatrics (Licence: CA A196458) | |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2024-09-25 |