| NPI | 1770535262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: TX P0944) |
| Additional Taxonomies | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: WI 41200) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: WI 41200-020) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2011-12-12 |