| NPI | 1952495152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: TX P3690) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD H0065115) |
| 208000000X Pediatrics (Licence: VA 0102201890) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2012-08-07 |