| NPI | 1972958726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MO 2020020199) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2020020199) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MO 2020020199) | |
| Enumeration Date | 2016-04-29 |
| Last Update Date | 2024-04-25 |