| NPI | 1649920265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: NC 2026-01173) |
| Additional Taxonomies | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: VA 0102209178) |
| 208000000X Pediatrics (Licence: VA 0102209178) | |
| Enumeration Date | 2022-03-26 |
| Last Update Date | 2026-03-19 |