| NPI | 1992061030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO DR.0060555) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX BP10042717) |
| 207R00000X Internal Medicine (Licence: TX BP10042717) | |
| 208000000X Pediatrics (Licence: NM RS2013-0525) | |
| Enumeration Date | 2012-04-03 |
| Last Update Date | 2018-08-17 |