| NPI | 1689020612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics Pediatric Emergency Medicine (Licence: GA 82391) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 82392) |
| 208000000X Pediatrics (Licence: NC 218162) | |
| Enumeration Date | 2016-05-09 |
| Last Update Date | 2022-05-25 |