| NPI | 1942366257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: TX U2511) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX U2511) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2024-07-11 |