| NPI | 1770712960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 96096) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX T8184) |
| 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: NY 278897) | |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2025-04-01 |