| NPI | 1801355607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: GA 99101) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 99101) |
| 208000000X Pediatrics (Licence: FL OS18983) | |
| 208000000X Pediatrics (Licence: MS 30451) | |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2025-06-06 |