| NPI | 1730290636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 6048152-1205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: UT 60481521205) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2021-09-06 |