| NPI | 1679595045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics Pediatric Emergency Medicine (Licence: TX L9869) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX L9869) |
| 2080S0010X Pediatrics Sports Medicine (Licence: TX L9869) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2021-06-17 |