| NPI | 1710964242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: AZ 27367) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ 27367) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: TX P4732) | |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2022-07-21 |